January 6, 2001

Ritalin and the Intolerance of Temperamental Diversity in America

As a behavioral pediatrician for the past twenty years I have evaluated and treated over two thousand children for their behavior and school problems. Iíve written many Ritalin prescriptions, the stimulant used to treat ADD (short for Attention Deficit Disorder or hyperactivity). Beginning in the early 1990s, I began to see a new kind of ADD candidate, younger than six, teenagers and adults. Many of the children seemed far less impaired by their personalities compared to the previous generation of patients. Nevertheless, their parents and teachers were concerned.

I wondered if Tom Sawyer or Huck Finn was brought to my office tomorrow whether or not, after evaluating their family and school environments, they would ultimately leave with a prescription for Ritalin. I am not the only doctor writing more Ritalin prescriptions these days. The production and use of the drug has increased by 700% since 1990. In 1998 the United States used 84% of the world's Ritalin. What's behind this increase and why us?

The demands on children have grown while the social supports to them, their families and schools have decreased. There exists a rampant educational paranoia that declares everyone must get a college degree. Children are expected to learn earlier and more yet we have larger student-teacher ratios in the general education classroom. Parents are also working harder and longer which means less time for their children and more structured day-care and latch key kids. Parents are additionally handicapped by a cultural parenting philosophy that says, if you know how to talk to Johnny he'll listen to you. Unfortunately, from my experience if you try talking to ADD Johnny he's halfway down the street before you've finished your first sentence. More HMO healthcare means more quick-fix medication and being labeled ADD gets you special services at school.

Children in England and Japan use one-tenth the Ritalin we do so it couldn't just be today's fast paced life that makes us Ritalin unique among nations. Unlike those countries, we prize individuality and self-expression yet demand conformity at school. Limitations of class and intelligence are more accepted in London and Tokyo. Here we have the American Dream where anyone can be the next Bill Gates. We also believe in a medical utopia where all the problems of life can be solved by visiting the doctor and taking a pill. And our state religion is corporate consumer fundamentalism ñ material acquisition will lead to emotional and spiritual contentment. Performance enhancers like Ritalin, Prozac and Viagra are in.

ADD is increasingly viewed by experts as biological and genetic. They say there is nothing good about an ADD personality. They compare impulsivity to having lower intelligence. I don't know how they can be so sure. Defining what's good is tricky business. Traditional IQ scores predict life contentment less well than emotional intelligence. Theories of multiple intelligences include creativity. Many of our most successful people played off their temperament or learning weaknesses in school and developed valuable skills that served them and others well (once they left high school). Benjamin Franklin, Thomas Edison, and Bill Clinton have all been described as being ADD.

No doubt a core group of ADD children will struggle in any environment. But an intolerance of temperamental diversity currently exists in our country that views our present day Tom Sawyers as nothing but genetic detritus. Human diversity in the past has contributed to the richness of our culture and civilization. I worry about a society where there's no place for an unmedicated Tom. He is so many of our sons and daughters.

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